Effect of positive end-expiratory pressure on gastric insufflation during induction of anaesthesia when using pressure-controlled ventilation via a face mask: A randomised controlled trial
BACKGROUND Face mask ventilation (FMV) during induction of anaesthesia is associated with risk of gastric insufflation that may lead to gastric regurgitation and pulmonary aspiration. A continuous positive airway pressure (CPAP) has been shown to reduce gastric regurgitation. We therefore hypothesised that CPAP followed by FMV with positive end-expiratory pressure (PEEP) during induction of anaesthesia would reduce the risk of gastric insufflation. OBJECTIVE The primary aim was to compare the incidence of gastric insufflation during FMV with a fixed PEEP level or zero PEEP (ZEEP) after anaesthesia induction. A secondary aim was to investigate the effects of FMV with or without PEEP on upper oesophageal sphincter (UES), oesophageal body and lower oesophageal sphincter (LES) pressures. DESIGN A randomised controlled trial. SETTING Single centre, Department of Anaesthesia and Intensive Care, Örebro University Hospital, Sweden. PARTICIPANTS Thirty healthy volunteers. INTERVENTIONS Pre-oxygenation without or with CPAP 10 cmH2O, followed by pressure-controlled FMV with either ZEEP or PEEP 10 cmH2O after anaesthesia induction. MAIN OUTCOME MEASURES A combined impedance/manometry catheter was used to detect the presence of gas and to measure oesophageal pressures. The primary outcome measure was the cumulative incidence of gastric insufflation, defined as a sudden anterograde increase in impedance of more than 1 kΩ over the LES. Secondary outcome ...
ConclusionThere is no need to alter the dosage of oral anticoagulants prior to dental extractions provided the INR is within the therapeutic range of 2.0 –4.0, extractions are done in least traumatic manner and local measures are used to control postoperative hemorrhage, thereby reducing the risk of thromboembolic episodes in these patients.
AbstractBackgroundVazirani –Akinosi nerve block technique is an established and a reliable technique to achieve anaesthesia in mandible with high success rate and is useful in cases where Halstead’s technique fails to provide desired anaesthetic effect.Materials and MethodsA total of 140 ASA-I or ASA-II patients, both genders, between 16 and 45 years who required extraction of mandibular tooth were divided into two groups. Group A received nerve block through Halstead technique, while Group B received nerve block through Vazirani–Akinosi technique with 2% lignocaine containing 1:200,000 adrenaline. ...
Authors: Braga AFA, Teixeira CEFA, Carvalho VH PMID: 31607376 [PubMed - as supplied by publisher]
This study suggested that the recurrence rate of tenosynovial giant cell tumors of the hand was closely related to the tumor number and tumor growth patterns.
Conclusions Labiolysis is a simple surgical operation with a short learning curve, which relieves symptoms, improves quality of life associated with iatrogenic labium minus fusion, and provides an esthetically pleasing surgical outcome. In this study group, no minor and no major surgical complications were observed, and no reoperation was performed.
Authors: Rajab TK Abstract The rat is an important model organism for lung transplantation research. Orthotopic rat lung transplantation is a complex procedure, which requires advanced microsurgical techniques. This technical paper describes in detail highly reproducible intraoperative microsurgical techniques and peri-operative management, including the donor procedure, recipient anesthetic management, the recipient operation and anticipated peri-operative complications. PMID: 31608698 [PubMed - as supplied by publisher]
Authors: Bodnar J Abstract The anesthetic propofol is used in a number of medical applications including surgery, procedural sedation, refractory status epilepticus, alcohol withdrawal, and critical care sedation. The manner in which it is dosed and administered in each environment varies, tailored to the specific task at hand. Because the use of propofol in end-of-life care is uncommon, providers may lack practical experience, and resources that are specific to this specialized application are not comprehensive and largely based on dosing and administration as it is done on the intensive care unit. The purpose of ...
I’m now in my third year out from residency in a private practice job. I did this a year or two ago and got some great questions from residents- go ahead and ask anything your little student or resident hearts desire. I’ll answer over the next few days. I did no fellowship, heavy residency emphasis on regional (my own choice) at a large, well regarded academic program. My job: large, physician owned group in Midwest. Split my time doing regional service, OR at large level 1 academic trauma... Three years out, AMA
I am a 4th year medical student and will be attending the ASA conference this weekend. I am planning on participating in the meet and greet with the program directors on Saturday in addition to other activities. Should I wear something business casual like khakis and a dress shirt, or should I wear a suit and tie to the conference? Thanks in advance.
I am a former CA-1 position who resigned from my program after being placed on academic probation. I understand that despite an otherwise good application, this fact will make it difficult to re-enter the field again. I have a state license and a DEA license. I reapplied broadly to Advanced and R0 positions in the match and emailed most programs. I genuinely believe I have remediated my issues. I am simply looking for advice on how I should increase my chances of getting interviews.